McClish D K, Powell S H, Montenegro H, Nochomovitz M
Department of Epidemiology and Biostatistics, Case Western Reserve University, Cleveland, Ohio 44106.
J Am Geriatr Soc. 1987 Nov;35(11):983-8. doi: 10.1111/j.1532-5415.1987.tb04000.x.
The impact of age on admission practices and pattern of care were examined in 599 admissions to a medical intensive care unit (MICU) and 290 patients on the conventional medical care divisions of the same hospital. Four age groups were compared: under 55, 55 to 64, 65 to 74, and 75 years of age and over. Severity of illness and prior health were assessed using the Acute Physiology Score (APS) and the Chronic Health Evaluation (CHE) instruments. Resource utilization was assessed using the Therapeutic Intervention Scoring System (TISS) and hospital charges. Patients 65 years of age and over comprised 48% of the MICU sample. The distribution of CHE was different among the four groups. Twenty-one percent of patients under 55 years of age had no prior chronic illness, as compared to less than 8% of older patients. The APS at admission was similar for all age groups, as was admission, daily, and total TISS. Hospital survival declined with age from 85% to 70%, while the likelihood of being designated do not resuscitate (DNR) increased from 10% to 24%. Differences in hospital survival disappeared when controlling for severity of illness and prior health, but differences in DNR status did not. Still, elderly DNR patients received as much resources as younger DNR patients and this was more than non-DNR patients. The sample of patients treated on conventional medical divisions had age distribution similar to the MICU sample. There was some evidence that admission APS (median, 5, 5, 6, 6, respectively, P = .055) and maximum APS (median, 5, 5, 7, 8, respectively, P = .023) differed slightly across age groups.(ABSTRACT TRUNCATED AT 250 WORDS)
在一家医院的医学重症监护病房（MICU）的599例入院患者以及同一医院传统内科护理科室的290例患者中，研究了年龄对入院方式和护理模式的影响。比较了四个年龄组：55岁以下、55至64岁、65至74岁以及75岁及以上。使用急性生理学评分（APS）和慢性健康评估（CHE）工具评估疾病严重程度和既往健康状况。使用治疗干预评分系统（TISS）和医院收费评估资源利用情况。65岁及以上的患者占MICU样本的48%。CHE在四个组中的分布不同。55岁以下的患者中，21%没有既往慢性病，而老年患者中这一比例不到8%。所有年龄组入院时的APS、入院时、每日和总的TISS相似。医院生存率随年龄从85%降至70%，而被指定为不进行心肺复苏（DNR）的可能性从10%增至24%。在控制疾病严重程度和既往健康状况后，医院生存率的差异消失，但DNR状态的差异未消失。尽管如此，老年DNR患者获得的资源与年轻DNR患者一样多，且比非DNR患者更多。在传统内科科室接受治疗的患者样本的年龄分布与MICU样本相似。有证据表明，不同年龄组的入院APS（中位数分别为5、5、6、6，P = 0.055）和最高APS（中位数分别为5、5、7、8，P = 0.023）略有差异。（摘要截断于250字）
